Articaine vs lidocaine – Which is better?
A JADA 2011 meta-analysis by Brandt showing what many dentists have thought for a long time….articaine works better than lidocaine. Articaine is up to almost 4 times more likely to produce profound pupal anesthesia in some areas of the mouth when compared to lidocaine. Articaine has been shown to be superior to lidocaine for infiltration in most areas, for example supplementary infiltration of lower first molars have been shown to be about equal but lower second molars articaine is twice as effective as lidocaine Shapiro JOE 2018. Articaine’s superiority for blocks is less apparent and perhaps non existent.
Another meta-analysis shows no difference for block or maxillary infiltration. It also found articaine to be superior in dealing with mandibular infiltration. My thought is, if there is a difference in one area there is in all areas but the difference may be clinically insignificant in those other areas OR may be too small to notice in a statistical manner. Articaine being a smaller molecule can get into areas lidocaine can’t so the mandibular infiltrations in dense bone work better and one could speculate that individuals with denser maxillary bone would have the same results. Kung JOE 2015
A list of most of the dental anesthetics used today can be found on my dental anesthetics page.
Articaine block = 26% success rate adding buccal infiltration with lido goes to 37% but articaine supplemental goes to 62%. Rogers JOE 2014
Shapiro JOE 2018 found that IANB was 25% successful. Additionally for first molars adding buccal infiltration with either lido or articaine was about the same but for second molars lidocaine was only 32% while articaine was 63%.
Toxicity of articaine vs lidocaine
Very interesting that the only neurotoxicity test I have ever seen shows 2% lidocaine to be more neurotoxic than 4% articaine. Albalawi 2018 Anesthesia Progress